Invasive pneumococcal disease in patients infected with HIV: still a threat in the era of highly active antiretroviral therapy

Clin Infect Dis. 2004 Jun 1;38(11):1623-8. doi: 10.1086/420933. Epub 2004 May 12.

Abstract

We studied all human immunodeficiency virus (HIV)-infected patients with invasive pneumococcal disease who received their diagnosis during 1996-2002 to investigate the incidence of this disease in the highly active antiretroviral therapy era and to study the influence of CD4 lymphocyte count on the clinical presentation and outcome of disease. The overall incidence of invasive pneumococcal disease was 11.3 cases per 100,000 person-years in adult patients without known HIV infection and 677 cases per 100,000 person-years in HIV-infected patients. This incidence remained stable over the study period. Clinical presentation, severity of illness, and number of recurrent episodes were similar in patients with CD4+ cell counts of >200 or < or =200 cells/ microL. Patients receiving trimethoprim-sulfamethoxazole (TMP-SMZ) were more likely to present with TMP-SMZ-resistant pneumococci than were those who were not receiving this agent (76.7% vs. 43.6%; P=.007). The mortality rate was high (21%).

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • AIDS-Related Opportunistic Infections / epidemiology
  • AIDS-Related Opportunistic Infections / mortality
  • Acquired Immunodeficiency Syndrome / epidemiology
  • Acquired Immunodeficiency Syndrome / mortality
  • Adult
  • Animals
  • Antiretroviral Therapy, Highly Active*
  • Comorbidity
  • Drug Resistance, Multiple, Bacterial
  • Female
  • HIV / isolation & purification*
  • HIV Infections / epidemiology*
  • HIV Infections / mortality*
  • Humans
  • Male
  • Microbial Sensitivity Tests
  • Pneumococcal Infections / drug therapy
  • Pneumococcal Infections / epidemiology*
  • Pneumococcal Infections / mortality*
  • Pneumocystis carinii / isolation & purification
  • Pneumonia, Pneumocystis / epidemiology
  • Pneumonia, Pneumocystis / mortality
  • Streptococcus pneumoniae / drug effects
  • Streptococcus pneumoniae / isolation & purification
  • Toxoplasma / isolation & purification
  • Toxoplasmosis, Cerebral / epidemiology
  • Toxoplasmosis, Cerebral / mortality
  • Trimethoprim Resistance
  • Trimethoprim, Sulfamethoxazole Drug Combination / metabolism
  • Trimethoprim, Sulfamethoxazole Drug Combination / therapeutic use

Substances

  • Trimethoprim, Sulfamethoxazole Drug Combination